Quan A, Kerlikowske K, Gueyffier F, Boissel J P
Section of General Internal Medicine, Department of Veterans Affairs, University of California, San Diego, USA.
J Gen Intern Med. 1999 Dec;14(12):718-29. doi: 10.1046/j.1525-1497.1999.12198.x.
To assess whether the relative and absolute benefit of hypertension treatment in women varies with age or race.
Systematic review of studies from 1966 to 1998 using MEDLINE, reviews, and consultation with experts. Eleven randomized controlled trials of pharmacologic treatment of prJgiary hypertension with cardiovascular morbidity and mortality outcomes were selected, with a pooled population of 23,000 women. Relative risks were combined for each end point to form a summary risk ratio using meta-analytic techniques based on a random-effects model. Summary risk ratios were converted to numbers needed to treat (NNTs). Data were dichotomized by age to approxJgiate menopausal status (30 to 54 years, and 55 years and older), and by race (white and African American).
In women aged 55 years or older (90% white), hypertension treatment resulted in a 38% risk reduction in fatal and nonfatal cerebrovascular events (95% confidence interval [CI] 27%, 47%; 5-year NNT 78), a 25% reduction in fatal and nonfatal cardiovascular events (95% CI 17%, 33%; 5-year NNT 58), and a 17% reduction in cardiovascular mortality (95% CI 3%, 29%; 5-year NNT 282). In women aged 30 to 54 years (79% white), hypertension treatment resulted in a 41% risk reduction in fatal and nonfatal cerebrovascular events (95% CI 8%, 63%; 5-year NNT 264), and a 27% risk reduction in fatal and nonfatal cardiovascular events (95% CI 4%, 44%; 5-year NNT 259). Hypertension treatment in African-American women (mean age, 52 years) reduced the risk of fatal and nonfatal cerebrovascular events by 53% (95% CI 29%, 69%; 5-year NNT 39), fatal and nonfatal cardiovascular events by 45% (95% CI 18%, 63%; 5-year NNT 21), fatal and nonfatal coronary events by 33% (95% CI 6%, 52%; 5-year NNT 48), and all-cause mortality by 34% (95% CI 14%, 49%; 5-year NNT 32). Analyses in white women aged 30 to 54 years did not show any statistically significant treatment benefit or harm.
Hypertension treatment lowers the relative and absolute risk of cardiovascular morbidity and mortality in women aged 55 years and older and in African-American women of all ages. A greater effort should be made to increase awareness and treatment in these groups of women. Although relative risk reductions for cerebrovascular and cardiovascular events are sJgiilar for younger and older women, the NNT of younger women is at least 4 tJgies higher. Decisions about treatment of hypertension in younger white women should be influenced by the individual patient's absolute risk of cardiovascular disease.
评估女性高血压治疗的相对和绝对获益是否随年龄或种族而变化。
对1966年至1998年的研究进行系统评价，采用医学主题词表（MEDLINE）检索、综述及专家咨询。选取11项关于原发性高血压药物治疗并伴有心血管发病和死亡结局的随机对照试验，汇总人群为23000名女性。使用基于随机效应模型的荟萃分析技术，将每个终点的相对风险合并，以形成汇总风险比。汇总风险比转换为需治疗人数（NNT）。数据按年龄分为近似绝经状态（30至54岁和55岁及以上），并按种族（白人和非裔美国人）进行二分法分类。
在55岁及以上的女性（90%为白人）中，高血压治疗使致命和非致命脑血管事件风险降低38%（95%置信区间[CI] 27%，47%；5年NNT 78），致命和非致命心血管事件风险降低25%（95% CI 17%，33%；5年NNT 58），心血管死亡率降低17%（95% CI 3%，29%；5年NNT 282）。在30至54岁的女性（79%为白人）中，高血压治疗使致命和非致命脑血管事件风险降低41%（95% CI 8%，63%；5年NNT 264），致命和非致命心血管事件风险降低27%（95% CI 4%，44%；5年NNT 259）。非裔美国女性（平均年龄52岁）的高血压治疗使致命和非致命脑血管事件风险降低53%（95% CI 29%，69%；5年NNT 39），致命和非致命心血管事件风险降低45%（95% CI 18%，63%；5年NNT 21），致命和非致命冠状动脉事件风险降低33%（95% CI 6%，52%；5年NNT 48），全因死亡率降低34%（95% CI 14%，49%；5年NNT 32）。对30至54岁白人女性的分析未显示出任何统计学上显著的治疗获益或危害。
高血压治疗可降低55岁及以上女性以及各年龄段非裔美国女性心血管发病和死亡的相对和绝对风险。应加大力度提高这些女性群体的认识并促进治疗。尽管年轻和年长女性脑血管和心血管事件的相对风险降低相似，但年轻女性的NNT至少高出4倍。年轻白人女性高血压治疗的决策应受个体患者心血管疾病绝对风险的影响。
